Balloon Eustachian tuboplasty
In balloon Eustachian tuboplasty (BET), a balloon catheter is inserted into the Eustachian tube under endoscopic visualisation and subsequently inflated. The treatment principle is that balloon dilatation of the Eustachian tube may restore its normal function, although the exact mechanism is not well-established.[97]Tucci DL, McCoul ED, Rosenfeld RM, et al. Clinical consensus statement: balloon dilation of the Eustachian tube. Otolaryngol Head Neck Surg. 2019 Jul;161(1):6-17.
https://aao-hnsfjournals.onlinelibrary.wiley.com/doi/10.1177/0194599819848423
http://www.ncbi.nlm.nih.gov/pubmed/31161864?tool=bestpractice.com
[98]Tisch M, Maier H, Sudhoff H. Balloon dilation of the Eustachian tube: clinical experience in the management of 126 children. Acta Otorhinolaryngol Ital. 2017 Dec;37(6):509-12.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5782429
http://www.ncbi.nlm.nih.gov/pubmed/29327736?tool=bestpractice.com
[99]Ockermann T, Reineke U, Upile T, et al. Balloon dilation eustachian tuboplasty: a feasibility study. Otol Neurotol. 2010 Sep;31(7):1100-3.
http://www.ncbi.nlm.nih.gov/pubmed/20657335?tool=bestpractice.com
[100]Kivekäs I, Chao WC, Faquin W, et al. Histopathology of balloon-dilation Eustachian tuboplasty. Laryngoscope. 2015 Feb;125(2):436-41.
http://www.ncbi.nlm.nih.gov/pubmed/25154612?tool=bestpractice.com
This procedure was initially described in adults and has recently been investigated for treatment in children. In adults, BET has been associated with OME resolution in 50% to 66% of patients.[101]Schröder S, Reineke U, Lehmann M, et al. Chronic obstructive eustachian tube dysfunction in adults: long-term results of balloon eustachian tuboplasty [in German]. HNO. 2013 Feb;61(2):142-51.
http://www.ncbi.nlm.nih.gov/pubmed/22915275?tool=bestpractice.com
[102]McMurran AEL, Hogg GE, Gordon S, et al. Balloon Eustachian tuboplasty for Eustachian tube dysfunction: report of long-term outcomes in a UK population. J Laryngol Otol. 2020 Jan;134(1):34-40.
http://www.ncbi.nlm.nih.gov/pubmed/31910908?tool=bestpractice.com
In children, BET has been found to be associated with an improvement in air-bone gap of 18 dB, compared to an improvement of 8 dB in the tympanostomy tube group.[103]Demir B, Batman C. Efficacy of balloon Eustachian tuboplasty as a first line treatment for otitis media with effusion in children. J Laryngol Otol. 2020 Nov 18;1-4.
http://www.ncbi.nlm.nih.gov/pubmed/33203498?tool=bestpractice.com
Furthermore, BET performed in conjunction with tympanostomy tube placement may extend the hearing benefit associated with the tympanostomy tubes.[104]Chen S, Zhao M, Zheng W, et al. Myringotomy and tube insertion combined with balloon eustachian tuboplasty for the treatment of otitis media with effusion in children. Eur Arch Otorhinolaryngol. 2020 May;277(5):1281-7.
http://www.ncbi.nlm.nih.gov/pubmed/32002612?tool=bestpractice.com
Specifically, similar hearing thresholds were found between the BET and tympanostomy tube groups at 6 months after-surgery. At 12 and 18 months, the air-bone gaps observed in the BET group were less than those observed in the tympanostomy tube group.[104]Chen S, Zhao M, Zheng W, et al. Myringotomy and tube insertion combined with balloon eustachian tuboplasty for the treatment of otitis media with effusion in children. Eur Arch Otorhinolaryngol. 2020 May;277(5):1281-7.
http://www.ncbi.nlm.nih.gov/pubmed/32002612?tool=bestpractice.com
In adults, guidelines indicate that BET may be considered in dilatory Eustachian tube dysfunction where medical therapy has failed.[97]Tucci DL, McCoul ED, Rosenfeld RM, et al. Clinical consensus statement: balloon dilation of the Eustachian tube. Otolaryngol Head Neck Surg. 2019 Jul;161(1):6-17.
https://aao-hnsfjournals.onlinelibrary.wiley.com/doi/10.1177/0194599819848423
http://www.ncbi.nlm.nih.gov/pubmed/31161864?tool=bestpractice.com
There are currently no guidelines on the use of BET for managing OME in adults or children. The evidence is still evolving and there is no consensus.